Provider Demographics
NPI:1669837332
Name:CRAFTER, TRAVIS (LPC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:CRAFTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3490
Mailing Address - Country:US
Mailing Address - Phone:478-301-4111
Mailing Address - Fax:478-301-2272
Practice Address - Street 1:250 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3490
Practice Address - Country:US
Practice Address - Phone:478-301-4111
Practice Address - Fax:478-301-2272
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GALPC011473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health